Prevention practices free essay sample

The United States Centers for Disease Control estimates that each year one in twenty hospital patients will contract a Healthcare Associated Infection (HAI). When further examined, the number of infected patients is approximately 1. 7 million per year resulting in nearly 99,000 deaths (CDC, 2011). Due to numbers like this, healthcare organizations, professional associations, and patient advocacy groups have all launched initiatives showing a universal response to this national healthcare priority. Chief among these initiatives was the collaboration between The Society for Healthcare Epidemiology of America and the Disease Society of America. The SHEA-IDSA joint publication on HAI prevention builds a professional foundation for healthcare facilities in the Unites States to mitigate the risk of HAI infected patients. The prevention strategies begin by identifying the most common HAIs, their causes, and detailing the both the human and financial costs associated with HAIs. Using this information, SHEA and ISDA created prevention strategies to combat each HAI. This essay will follow the SHEA-IDSA template by detailing information on the most common Healthcare Associated Infection and provide detailing prevention strategies. According to the United States Centers for Disease Control and the SHEA-IDSA report, the most common Healthcare Associated Infection are Central Line Associated Blood Stream Infections or CLABSI. With nearly 50% of all ICU patients requiring a central line, the amount of recorded CLABSI infections is extremely high. The research on CLABSI indicates the most common pathogens are Staphylococcus Aureus, Enterococci, and Candida. To better understand the nature of CLABSI incident and therefore employ prevention strategies one must understand the dynamic of a central line. The National Healthcare Safety Network defines a central line as â€Å"a catheter whose tip terminated in a great vessel† (IHI, 2011). The catheter on a central line punctures the skin, which by default makes bacterial and fungal infections possible. Once the infection has entered the body it can spread to the blood stream. The infection can then cause hemodynamic changes possibly causing death of a patient. Proof of an infection is found in the recovery of a pathogen from a blood culture from a patient who had a central line. For declarative purposes, a pathogen not commonly present on the skin must only be found in one culture whereas a pathogen commonly found on the skin must be detected in two or more cultures. In order to be confirmed as a central line infection, the central line must have been installed a minimum of two days prior to the development of the infection and there must be no other apparent source of the infection. Regarding the cost of Healthcare Associated Infections; both are indicators of the enormity of the problem. As mentioned earlier the 2010 CDC report titled â€Å"Preventing Healthcare-Associated Infections† stated 1. 7 million cases occur each year in the United States. According to the same report 99,000 cases result in death. The Institute for Healthcare Improvement estimates that of these 99,000 deaths, up to 4,000 are a direct result of bloodstream infections. The human cost dwarves the financial costs, which alone have a crippling effect on the healthcare industry. Reflecting on the Institute for Healthcare Improvement report, each CLABSI incident prolongs hospitalization on average of seven days. Each infection costs between $3,700 and $29,000. Having established the common CLABSI incidents, identifying the risk of infection, and examining the cost, it is time to move into prevention strategies. The Institute for Healthcare improvement established the industry standard for central line infection strategies in what are known as Care Bundles. â€Å"The IHI â€Å"Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually. The five components of the bundle are proper hand hygiene, maximum barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity. The most basic step in CLABSI prevention is hand washing. (IHI, 4/23/2011) The IHI guidelines specify that healthcare professionals need to wash hands before and after catheter care, when dressings are changed, and the central lines are accessed. Furthermore patients should be taught when and how to properly wash hands. This education extends to family members of  the patients. Along with basic hygiene, patients should also be taught to avoid handling or manipulating central lines. Emphasis on sterility and hygiene are reinforced in the second IHI guideline known as Maximum Barrier Precautions. The medical stuff is required to wear caps, masks, sterile gowns, and sterile glove when central lines are inserted. The patient must also be covered head to toe with a sterile drape except for a small opening at the catheter insertion site. (IHI, 4/30/2011) The third IHI precaution is Chlorohexidine. Studies indicate using Chlorohexidine for skin preparation prior to central line insertion or when changing dressings is more effective than other solutions such as povidone-iodine or alcohol. To properly cleanse the treatment area, Chlorohexidine must be applied for at least 30 seconds and the solution must dry completely before inserting a central line. The use of antiseptics like Chlorohexidine is not reserved just for patients. Studies have shown that coating or impregnating catheters with antiseptics have reduced the risk of infections. The overall benefits however are questionable when examining the practice from a cost benefit perspective. This is due to statistically insignificant differences in the rate of infections when using impregnated or non-impregnated catheters. (Lai, N. et al, 2013) The next precautions cited in the IHI bundle are optimal catheter site selection and daily central line review (IHI, 4/30/11-B). One key component of site selection is found in conducting a risk/benefit analysis. The treating physician is capable of such an analysis. In general the IHI guidelines suggest avoiding the femoral artery for central lines. When treating adult patients, they also suggest a preference to the subclavian site over a jugular site when using non-tunneled central lines. A daily review of a patient’s central line is also necessary. The risk of infection increases the longer a catheter is in place therefore a daily check must be conducted to ensure the line is still needed. A daily review will also facilitate the removal of un-needed lines. It is important to note that scheduling catheter removals or replacement at scheduled intervals, every three days for example, has not lowered the risk of infection. The key element missing in scheduled removals is the daily, in-person review. Implementation and compliance of IHI Bundle Precautions is multi-faceted requiring continuing education and revised staffing practices (NGC, 2013). Healthcare professionals must be trained in proper procedures for avoiding central line infections. Procedures include catheter insertion and maintenance. To ensure the guidelines are followed and the education is effective, each healthcare site should enact a compliance committee and empower the committee to conduct periodic reviews of central line procedures. Among the many precautions cited above the committee should create a central line checklist and make the checklist available to all staff members. Furthermore the committee can create a culture of central line safety by ensuring cleaning agents are prominently placed at all hand-washing stations, each supply chart stocked with chlorhexidine kits and other sterile items like masks and gloves. Physical compliance checks would also be in the purview of the committee and can be seen in the form of integrating daily central line checks with multidisciplinary rounds and requiring central line records showing the date and time of the line placement. The compliance committee will also be charged with reviewing the facility’s staffing procedures. This is necessary because studies indicate the risk of patient central line infection increases when there is an elevated patient to nurse ratio. The studies have also indicated that the use of â€Å"pool nurses† in ICU settings contributes to increased risk of infection. Where IHI guidelines were introduced and adhered to, the number of CLABSI incidents dramatically decreased. For example, from 2001 to 2009 there was a 58% reduction which saved nearly $1. 8 billion in excess healthcare costs. This represents nearly 6,000 lives saved through proper protocols. When looking at two years in this range, 2008 and 2009, the reductions are impressive. For example, in 2008 there were approximately 37,000 cases of central line infections in patients receiving outpatient hemodialysis. In 2009 there were 23,000 cases among patients receiving inpatient treatment. While the number of cases in these areas is still high, the statistics reveal they are declining (CDC, 2011). The authors of this paper had the opportunity to complete their clinical hours at two different facilities; Banner Health Network and Dignity Network. The authors found that both facilities set a goal of completely eliminating CLABSI and created a culture to facilitate this goal. Aside form the overall improvement in patient care such a goal will be financially beneficial for the facilities. This is in large part due to changes in funding rules that state healthcare facilities will no longer be reimbursed for CVC associated bloodstream infections because they are considered to be largely preventable. Both facilities visited by the authors strictly adhere to the IHI central line bundle concept. Each of them also added new elements to make the bundle even more successful. For example, both sites use biopatch to prevent bacteria access at the site of a CVC insertion. They also instituted guidelines for routine dressing changes and cover the line hubs with alcohol-impregnated caps when lines are not in use. In addition, both facilities empower nurses to supervise the insertion procedure and stop the procedure if any steps are skipped. As covered previously, catheter-related bloodstream infections cause life threatening complications, increase morbidity, dramatically increase expenses and above all are largely preventable. Study after study on the issue proves that adherence to strict guidelines pertaining to central line treatment, like the IHI bundle, dramatically decreases the number of CLABSI incidents and the amount of money spent on treatment. Instituting and maintaining a culture focused on CLABSI prevention is necessary in all healthcare facilities. Such a culture not only fosters a safe treatment environment but also allows each healthcare professional to personally advocate for their patients’ health and recovery.